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New User Out Of The Shadows
#1
New User Out Of The Shadows
Hi All!  Greetings from Colorado. After lurking for a few weeks, I’ve joined, donated, downloaded Sleepyhead and now seeking help with all of my newfound information. I would like to give some background information that might be helpful in determining what I may need to do in-order to fine tune my treatment .  6’, 195 pounds.  I’ve been in treatment for esophageal cancer for the past six years.  Radiation treatment had been used on tumors that had spread to my liver and brain.  During the past six years I have been through 4 different chemo regimens and during the past 18 months, I have been involved in an immunotherapy clinical trial. I had to leave the trial do to the damage that the trial drug has had on my heart causing congestive heart failure.  It is believed that the effects of the congestive heart failure will  be lessened or eliminated because it was not caused by a heart attack.  The tumor is metastatic to the bone in my right hip and is being monitored.  Pain is well managed.  

I was diagnosed with sleep apnea in August 2018 after taking an in-home sleep apnea test and am currently  supplementing my CPAP  with oxygen at 3.0 liters per minute.  Two or 3 weeks in, my machine was changed to a BiPAP.  After another week, I was changed back to my initial machine with the addition of the supplemental oxygen.  I believe that no one wants to take the time to figure out how to approach my treatment and currently, I am just out here with no real follow through. My AHI numbers are all over the place.  Been as high as the thirties and down into single digits. This is what prompted me   to look for answers on my own.  Any input would be greatly appreciated.

Notes: Severe mixed sleep apnea noted, with a total AHI of 59.2 events per hour.  The central apnea index was 22.8i/hour with >50% of the events being periodic breathing (cycle length ranging from 34 sec to 43 sec).  Chronic opioid use is noted in the chart.  Events were mildly increased in the supine position.  Hypoxia noted; average saturation was 89.3% and minimum saturation was 80.0%.  167.1 minutes were spent with an oxygen saturation less than 88%.  Moderate sleepiness noted with an ESS of 13 (normal <11, Mild 11-12, Moderate 13-15, Severe >15). 
Measurements included oxygen saturation, pulse rate, body position, airflow, and chest/abdominal movement.

Thank You!
Cowboy


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#2
RE: New User Out Of The Shadows
Welcome to the forum.  I'm not going to lie to you and tell you that this journey is going to be easy, it isn't.  But we, I assure you that I am not the only person here that can and will help you.

You have several issues going on that very likely impact your apnea.
Altitude, hey you are in Colorado, I don't see any indication it's an issue but we need to keep it in mind.
You currently have CHF, I would suggest approval from your cardiologist before upgrading.  
Is your periodic Breathing actually CSR?  Zoom in on the segment and we can see if it matches the pattern for CSR.
As you know your apnea is predominately central Apnea.


You hit many of the possible causes of Central Apnea, these are from the Mayo Clinic.
Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing. The cause varies with the type of central sleep apnea you have. Types include:

  • Cheyne-Stokes breathing (CSR) This type of central sleep apnea is most commonly associated with congestive heart failure or stroke. This condition is characterized by a gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.

  • Drug-induced apnea. Taking certain medications such as opioids — including morphine sulfate (Ms Contin, others), oxycodone (Oxycodone HCL, Oxycontin, others) or codeine sulfate — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to temporarily stop completely.

  • High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're exposed to a very high altitude. The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.

  • Complex sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as complex sleep apnea because it's a combination of obstructive and central sleep apneas.

  • Medical condition-induced central sleep apnea. Several medical conditions may give rise to central sleep apnea of the non-Cheyne-Stokes variety.

  • Idiopathic (primary) central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known.
Treatment.
Your ResMed AirSense 10 AutoSet is NOT designed to treat Central Apnea, Thus with your APAP we treat by trying to avoid Central events.
Generally, there is no absolute here,
Higher Pressures  tends to increase Central Events
Higher Pressure Variance both algorithmically and with Higher Pressure Support tends to increase Central Events
So we try to reduce Pressure and reduce Pressure Variance to avoid Central events and come to a comfortable middle.

The machine that treats Central Apnea is the RedMed AirCurve 10 ASV.  This is the only machine (by ResMed) designed to treat Central and Mixed Apnea. This works with fairly low pressures and a high Pressure Support when a  Central event is occuring.  Typically reduces AHI well under 5 and many get "Near Zero" AHIs

ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea and as such you need to be medically cleared.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
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Dealing with a DME
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: New User Out Of The Shadows
(04-22-2019, 01:36 PM)bonjour Wrote: You currently have CHF, I would suggest approval from your cardiologist before upgrading.  
Is your periodic Breathing actually CSR?  Zoom in on the segment and we can see if it matches the pattern for CSR.
As you know your apnea is predominately central Apnea.

Hey bonjour, thanks so much for quick reply. I truly have a lot of balls up in the air.  I hope this screenshot is correct for the 1st CSR that you are looking for.  I will be having a new echo taken on May 6th. That should give me a better idea on the CHF. I believe that the cardiologist will not even talk to me without it.  Imagine a self-important doctor in a tv series and you have my guy.

As far as the rest of the points that you outlined from Mayo sound like they have been written for me or about me.  In the meantime, I'm just in the old "hurry-up and wait" mode.

Cowboy


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#4
RE: New User Out Of The Shadows
That is periodic breathing, Not CSR, it lacks the pauses between the cycles.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: New User Out Of The Shadows
Hmmm...I'm sorry bonjour. I'm not familiar with which chart will show the CSR data when I zoom in.  Dont-know

Cowboy
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#6
RE: New User Out Of The Shadows
(04-22-2019, 10:32 PM)Cowboy Bob Wrote: Hmmm...I'm sorry bonjour. I'm not familiar with which chart will show the CSR data when I zoom in.  Dont-know

Cowboy

Great zoom on the area your machine has flagged as CSR but what Bonjour is saying is that whilst this was flagged as CSR it is not actually CSR but just periodic breathing.
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#7
RE: New User Out Of The Shadows
When a quest arises,or we have a question we often like to see a zoomed view of data flow as it is the single most informative chart. And we interpret it manually to validate what it says.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: New User Out Of The Shadows
(04-22-2019, 11:33 PM)jaswilliams Wrote:
(04-22-2019, 10:32 PM)Cowboy Bob Wrote: Hmmm...I'm sorry bonjour. I'm not familiar with which chart will show the CSR data when I zoom in.  Dont-know

Cowboy

Great zoom on the area your machine has flagged as CSR but what Bonjour is saying is that whilst this was flagged as CSR it is not actually CSR but just periodic breathing.

Thank you for the clarification  jaswilliams. I was reading it with a completly different  meaning. Smile

Cowboy
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#9
RE: New User Out Of The Shadows
(04-23-2019, 06:40 AM)bonjour Wrote: When a quest arises,or we have a question we often like to see a zoomed view of data flow as it is the single most informative  chart.  And we interpret it manually to validate what it says.

bonjour, I would like to kind of put things on hold for the 2 weeks until I have the echo. I will be able to see if the CHF is improving and at that point, perhaps make the cardiologist an advocate for the AVS machine.  As I get closer to that date, I'll shoot you a ping and we can craft a plan for me to work with the sleep dept and get this new machine.  Sound ok?

Cowboy
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#10
RE: New User Out Of The Shadows
Read this Justifying ASV
and this Justifying_ASV_backup_Info
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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